Zalaba Z, Tihanyi T F, Winternitz T, Nehéz L, Flautner L
1st Department of Surgery, Semmelweis University of Medicine, Budapest, Hungary.
Acta Chir Hung. 1999;38(2):221-3.
The incidence of cystic liver lesions seems to be more frequent as previously suggested. The treatment of symptomatic non-parasitic cysts is controversial. Ultrasonography (US) or computer tomography (CT) guided drainage and/or sclerotization versus surgical fenestration or partial resection, even liver resection has been advocated. Recently with the development of laparoscopic surgery this minimal invasive approach was also applied in the surgical treatment of single or multiple cystic lesions. Between 1994 and April 1999 21 patients with non-parasitic cysts were treated by laparoscopic fenestration or partial resection at the 1st Department of Surgery, Semmelweis University of Medicine. In 13 cases the symptomatic cyst presented the indication for surgery, while in the others cholelithiasis and GERD was the primary cause of intervention in 7 and 1 patient respectively. There were 16 woman and 5 men with a mean age of 42.3 years (17-78). The cyst was solitary in 17 cases and multiple 3-6-number in four patients. The size varied between 1.5-25 cm (average 7.2 cm). Patients were selected for the laparoscopic approach according to the US and/or CT appearance and superficial localization of the cyst. Wide unroofing or partial resection of the cyst wall till the margin of normal liver tissue was performed in all cases. The cystic cavity was drained. All operations were completed laparoscopically. Intraoperative complication did not occur. Bleeding from the resected margin could be well controlled by electrocautery or clipping. Patients left the ward after the drains were removed on postoperative day 2-4 depending upon the amount of serious discharge. No complication was observed postoperatively. During the average of 12.5 months (1 to 54 months) follow-up of 19 patients no recurrence was observed. Two patients required reoperation. In one 17 year old male patient cystadenocarcinoma was verified by histology, upon reoperation the lesion was found unresectable. In another case left hemi-hepatectomy was performed because of cyst recurrence caused by cholangiocell adenoma. In selected cases of superficially located symptomatic, non-parasitic cysts the laparoscopic fenestration might be the first choice of treatment. The method is safe and effective in the hands of surgeons experienced in both laparoscopic and liver surgery. Careful exploration of the cystic cavity and histological examination of the resected cyst wall is mandatory to avoid diagnostic mishaps.
肝囊肿性病变的发生率似乎比之前认为的更为常见。有症状的非寄生虫性囊肿的治疗存在争议。有人主张采用超声（US）或计算机断层扫描（CT）引导下的引流和/或硬化治疗，以及手术开窗或部分切除，甚至肝切除。近年来，随着腹腔镜手术的发展，这种微创方法也被应用于单个或多个囊性病变的手术治疗。1994年至1999年4月期间，塞梅尔维斯医科大学第一外科对21例非寄生虫性囊肿患者进行了腹腔镜开窗或部分切除术。13例中有症状的囊肿是手术指征，其余病例中，分别有7例和1例患者的主要干预原因是胆结石和胃食管反流病（GERD）。患者中有16名女性和5名男性，平均年龄42.3岁（17 - 78岁）。17例囊肿为单发，4例患者为多发，3 - 6个不等。囊肿大小在1.5 - 25厘米之间（平均7.2厘米）。根据囊肿的超声和/或CT表现及浅表定位选择患者进行腹腔镜手术。所有病例均进行囊肿广泛开窗或囊肿壁部分切除直至正常肝组织边缘。囊肿腔进行了引流。所有手术均通过腹腔镜完成。术中未发生并发症。切除边缘的出血可通过电灼或钳夹得到很好的控制。患者术后2 - 4天，根据引流量多少在引流管拔除后离开病房。术后未观察到并发症。在对19例患者平均12.5个月（1至54个月）的随访中，未观察到复发。2例患者需要再次手术。1例17岁男性患者经组织学证实为囊腺癌，再次手术时发现病变无法切除。另一例因胆管细胞腺瘤导致囊肿复发而进行了左半肝切除术。在部分浅表性有症状的非寄生虫性囊肿病例中，腹腔镜开窗术可能是首选治疗方法。在有腹腔镜和肝脏手术经验的外科医生手中，该方法安全有效。必须仔细探查囊肿腔并对切除的囊肿壁进行组织学检查，以避免诊断失误。
